OP0215 WHAT DOES THE PATIENT WELL-BEING VAS TELL US WHEN THE PHYSICIAN GLOBAL ASSESSMENT SCORE IS ZERO? ANALYSIS OF A LARGE MULTINATIONAL DATASET
Authors: M. Burrone, R. Naddei, F. Ridella, C. Trincianti, C. Herrera Mora, C. Malagon, A. Ibañez, O. Arguedas, N. Ruperto, A. Ravelli, A. Consolaro
Journal: Annals of the Rheumatic Diseases (2022)

Background Parent- and child-reported outcomes (PCROs) are measures that reflect the parent and child perception of rheumatic disease course and effectiveness of therapeutic interventions. Among PCROs for the assessment of patients with juvenile idiopathic arthritis (JIA), the most widely adopted is the parent/patient global evaluation or well-being visual analogue scale (WB-VAS). Several studies in JIA have highlighted the discrepancies in the assessment of the disease status between the physician and the parent/patient. This difference might be due to the WB-VAS measuring a broader construct than the physician global assessment (PGA). Objectives To evaluate, in a large multinational sample of JIA patients, the disease characteristics of subjects considered as inactive by the physician with an increased WB-VAS score. Methods Data from the multinational dataset of patients enrolled in the Epidemiology Treatment and Outcome of Childhood Arthritis (EPOCA) study were analyzed. We have included only subjects with a PGA score of 0. PCROs were collected through the juvenile arthritis multidimensional assessment report (JAMAR). We compared demographic features, socio-economic status, level of education, subtype of JIA diagnosis and the main PCROs (pain level, presence of morning stiffness, count of joints with swelling or pain, functional ability, disease activity level, ongoing therapy, presence of medications side effects and health related quality of life measured with the pediatric rheumatology quality of life (PRQL) scale) between subjects with WB-VAS ≤ 1 and &gt; 1. Results A total of 3537 patients were sorted into two groups according to the WB_VAS score: 2862 subjects were included in a first group (WB_VAS ≤1); 675 in a second one (WB-VAS &gt;1). Respectively, 17,6% and 18,1% of families belonged to the lower socio-economic status, 70,5% and 71% to the intermediate, 11,9% and 10,8% to the higher. The percentages of patients in the three levels of education was not different in the two groups:20,2% and 22% in the lower, 48,9% and 50,1% in the intermediate, 30,8% and 27,9% in the higher level of education. No significant difference was observed in the distribution of JIA categories in the two groups. Subjects in first group were younger at disease onset (5.6 vs 6.4 years). Comparison of main PCROs results is presented in the Table 1 below. Table 1. PCROs WB_VAS ≤1 WB_VAS &gt;1 p VAS_Pain (mean) 0.3 (0.9) 2.4 (2.4) &lt;0.001 Presence of morning stiffness (%) 227 (8.0) 285 (42.4) &lt;0.001 Patients under treatment (%) 1919 (67.2) 540 (80.2) &lt;0.001 Reporting side effects (%) 421 (22.1) 236 (43.9) &lt;0.001 Number of adverse events to the therapy (mean) 0.2 (0.7) 0.8 (1.5) &lt;0.001 Juvenile Arthritis Functionality Scale (JAFS)Total Score (mean) 0.5 (1.6) 3.0 (4.4) &lt;0.001 JIA Quality of Life (JQL) Total Score (mean) 1.6 (2.3) 6.4 (4.4) &lt;0.001 VAS-Disease Activity (mean) 0.4 (1.3) 2.3 (2.4) &lt;0.001 Count of active joints (mean) 0.2 (0.7) 1.4 (2.2) &lt;0.001 Conclusion We have analyzed the variables that might determine a difference between the physician’s assessment of inactive disease and the parent’s/patient’s perception of well-being. In particular, socio-economic status, level of education, and gender representation seem not to impact on the general perception of well-being, while pain seems to have the greatest influence on the parent/patient quality of life assessment. Finally, children with lower WB-VAS score were younger at disease onset. References [1]Consolaro A, et al. Phenotypic variability and disparities in treatment and outcomes of childhood arthritis throughout the world: an observational cohort study.Lancet Child Adolesc Health. 2019 Apr;3(4):255-263. Disclosure of Interests None declared